Mediating Medicare: A primer on coverage and changes for 2011

Karen Sorensen

Thursday

Oct 21, 2010 at 12:01 AMOct 21, 2010 at 8:22 PM

Let’s face it — the prospect of signing up for Medicare can be daunting. “Seniors need to understand their eligibility and what additional coverage they need” before they enroll, says Christie Luke, director of financial operations for Rising Medical Solutions, a medical care management company based in Chicago. “They just can’t enroll at any time. Each program has periods and restrictions.” Here are five things Luke says you should know if you plan to enroll yourself or a family member in 2011.

Let’s face it — the prospect of signing up for Medicare can be daunting. “Seniors need to understand their eligibility and what additional coverage they need” before they enroll, says Christie Luke, director of financial operations for Rising Medical Solutions, a medical care management company based in Chicago. “They just can’t enroll at any time. Each program has periods and restrictions.” Here are five things Luke says you should know if you plan to enroll yourself or a family member in 2011.

1. Know your options. Part A is hospital insurance only, covering in-patient, rehabilitation, long-term, hospice and home health care. Part B covers 80 percent of doctor services, outpatient care and some preventative services. Part C allows you to go through a private company for care covered under A and B. Part D is prescription drug coverage, which you secure through a private company. You can’t get Medicare prescription assistance without signing up for A and B.

2. Know when to sign up. You’re automatically enrolled in parts A and B the day you turn 65, as long as you’re receiving Social Security or Railroad Retirement benefits. You don’t pay for Part A, but Part B is $110.50 a month. If you don’t receive Social Security or Railroad Retirement benefits but want Medicare, you’ll pay $461 a month for Part A and $110.50 for Part B.

3. Know how you’ll get penalized. The biggest hit comes if you don’t sign up for Part B when first eligible. You must wait for the next enrollment period, Jan. 1 to March 31 (this changes in 2011; those who miss enrollment next year can sign up from Oct. 15 to Nov. 7). You’ll pay a 10 percent penalty for every year you don’t participate after becoming eligible. You can get a delay if you’re getting insurance through your employer or your spouse’s, but you must request it. You’ll also be penalized if you don’t sign up for Part D when first eligible and decide later that you want it.

4. Know what’s new. There are a couple of changes in the Medicare plan in 2011. The biggest is, participants won’t pay a deductible or coinsurance for most preventive services and are eligible to receive a free wellness exam.

5. Know where to get help. You can get assistance by calling 800-633-4227. To get a new card, change your information, report a death or get information on eligibility, call 800-772-1213. To coordinate Medicare benefits with a private insurance plan, call 800-999-1118. If you’re a veteran, call 800-827-1000. Information’s also available at www.medicare.gov.

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